10009-ST-1 Usefulness of Preoperative Embolization for Glioblastoma

Abstract Surgery for glioblastoma requires both functional preservation and maximal resection. To achieve maximal safe resection, a surgical strategy utilizing multimodality is essential. We have routinely performed cerebral angiography prior to glioblastoma surgery to prioritise understanding of vascular anatomy in order to achieve maximal safe resection. Cerebral angiography enables the identification of the dominant hemisphere, feeders, arteries passing through eloquent areas. This information is highly useful for identifying and managing vessels during resection. The benefits of preoperative embolisation, as demonstrated by the embolisation of extramedullary tumours, include reduced surgical time and blood loss. We hypothesized that preoperative embolisation for deep or eloquent area glioblastoma may have a unique effect, where the embolisation material serves as a marker, aiding in the identification of anatomical landmarks during surgery. Considering the above benefits, we performed preoperative embolisation on glioblastoma. From December 2023 to May 2025, we performed preoperative embolisation on 15 patients with glioblastoma. The embolisation procedure was performed under local anaesthesia using 3Fr guiding sheath, with access via the distal radial artery. The embolisation time, including WADA test averaged 1 hour 25 minutes, resulting in minimal patient burden. Embolisation materials were selected based on their expected marking effects, including coil and NBCA. In the 15 cases we experienced, no complications related to embolisation were observed, including at the puncture site. Additionally, no ischemic changes beyond the resection margin were observed on postoperative MRI. Preoperative embolisation for glioblastoma not only reduces intraoperative blood loss but also contributes to the development of a bloodless surgical field and improved understanding of anatomical relationships through the marking effect of embolisation. This reduces the mental burden on the surgeon and enables the achievement of maximal safe resection. For patients, it is considered to contribute to functional preservation, reduced blood loss, and shorter surgery times, thereby alleviating physical burden.